Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX 77030, USA.
Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
Brain. 2024 Jul 5;147(7):2522-2529. doi: 10.1093/brain/awae027.
Lesions in the language-dominant ventral occipitotemporal cortex (vOTC) can result in selective impairment of either reading or naming, resulting in alexia or anomia. Yet, functional imaging studies that show differential activation for naming and reading do not reveal activity exclusively tuned to one of these inputs. To resolve this dissonance in the functional architecture of the vOTC, we used focused stimulation to the vOTC in 49 adult patients during reading and naming, and generated a population-level, probabilistic map to evaluate if reading and naming are clearly dissociable within individuals. Language mapping (50 Hz, 2829 stimulations) was performed during passage reading (216 positive sites) and visual naming (304 positive sites). Within the vOTC, we isolated sites that selectively disrupted reading (24 sites in 11 patients) or naming (27 sites in 12 patients), and those that disrupted both processes (75 sites in 21 patients). The anteromedial vOTC had a higher probability of producing naming disruption, while posterolateral regions resulted in greater reading-specific disruption. Between them lay a multi-modal region where stimulation disrupted both reading and naming. This work provides a comprehensive view of vOTC organization-the existence of a heteromodal cortex critical to both reading and naming, along with a causally dissociable unimodal naming cortex, and a reading-specific visual word form area in the vOTC. Their distinct roles as associative regions may thus relate to their connectivity within the broader language network that is disrupted by stimulation, more than to highly selective tuning properties. Our work also implies that pre-surgical mapping of both reading and naming is essential for patients requiring vOTC resections, as these functions are not co-localized, and such mapping may prevent the occurrence of unexpected deficits.
病变位于语言优势的腹侧枕颞叶皮质（vOTC）可能导致阅读或命名的选择性损伤，从而导致失读症或命名障碍。然而，功能成像研究显示命名和阅读的差异激活并没有揭示专门针对这些输入之一的活动。为了解决 vOTC 功能结构中的这种不和谐，我们在 49 名成年患者的 vOTC 进行了聚焦刺激，在阅读和命名时生成了一个群体水平的概率图，以评估个体内阅读和命名是否明显分离。语言映射（50Hz，2829 次刺激）在阅读（216 个阳性部位）和视觉命名（304 个阳性部位）期间进行。在 vOTC 内，我们分离出选择性破坏阅读（11 名患者中的 24 个部位）或命名（12 名患者中的 27 个部位）的部位，以及破坏这两个过程的部位（21 名患者中的 75 个部位）。前内侧 vOTC 更有可能导致命名障碍，而后外侧区域则导致更大的阅读特异性破坏。在它们之间是一个多模态区域，刺激会破坏阅读和命名。这项工作提供了 vOTC 组织的全面视图——存在一个对阅读和命名都至关重要的异模态皮质，以及一个因果可分离的单模态命名皮质，以及 vOTC 中的阅读特异性视觉词形区。它们作为关联区域的不同作用可能与它们在更广泛的语言网络中的连接有关，而不是与高度选择性的调谐特性有关。我们的工作还表明，对于需要 vOTC 切除的患者，阅读和命名的术前映射都是必不可少的，因为这些功能不在同一位置，并且这种映射可以防止意外缺陷的发生。
